Cohort design to assess the association between post-hospital primary care physician follow-up visits and hospital readmissions.

ABSTRACT

While multifaceted post-hospitalization interventions can succeed in preventing hospital readmissions, many of these interventions are labor-intensive and costly. We hypothesized that a timely post-discharge primary care physician (PCP) visit alone might prevent hospital readmission. We conducted a retrospective cohort study to assess whether post-hospitalization PCP visits within 14 days of discharge were associated with lower rates of 30-day hospital readmission. In a secondary analysis we also assessed whether visits with a PCP at 7-days post-discharge changed rates of hospital readmissions and whether post-hospitalization PCP visits were associated with decreased 90-day hospital readmissions. We included all adults with a PCP who were discharged from an inpatient medical service in a large, urban integrated academic health system from January 1, 2019 to September 9, 2019 in our analysis. We performed unadjusted bivariate analyses to measure the associations between having a PCP visit within 14 and 7 days of discharge and hospital readmission within 30 and 90 days. Then we constructed multivariate logistic regression models including patient medical and utilization characteristics to estimate the adjusted odds of a patient with a post-hospitalization PCP visit experiencing a 30-day hospital readmission (primary outcome) and 90-day readmission (secondary outcome). A total of 9236 patients were discharged; mean age was 57.9 years and 59.7% were female. Of the study population, 35.6% (n = 3284) and 24.1% (n = 2224) of patients had a post-hospitalization PCP visit within 14 days and or 7 days, respectively. Overall, 1259 (13.6%) and 2153 (23.3%) of discharged patients were readmitted at 30 and 90 days, respectively. In unadjusted analyses, having a post discharge PCP visit was not associated with decreased hospital readmission rates, but after adjusting for sociodemographic, medical and utilization characteristics, having a post-hospitalization PCP visit at 14 and 7 days was associated with lower hospital readmission rates at 30 days 0.68 (95% CI 0.59-0.79) and 0.76 (95% CI 0.66-0.89), respectively; and 90 days 0.76 (95% CI 0.68-0.85) and 0.80 (95% CI 0.70-0.91), respectively. In this large integrated urban academic health system, having a post-hospitalization PCP visit within 14- and 7-days of hospital discharge was associated with lower rates of readmission at 30 and 90 days. Further studies should examine whether improving access to PCP visits post hospitalization reduces readmissions rates.